International Society for Pediatric and Adolescent Diabetes
ISPAD 2014 | 40th Anniversary |
251
P163
Diabetes ketoacidosis in L-asparaginase therapy
M.P. Mabulac
1
1
University of the Philippines-Philippine General Hospital, Department of Pediatrics, Manila,
Philippines
Background:
Diabetic ketoacidosis (DKA) as a complication of L-asparaginase therapy in children
with acute lymphoblastic leukemia (ALL) is rare. We report a patient with B-C ell ALL who developed
DKA while on treatment with L-asparaginase.
Case:
E.C, 10 years old female admitted due abdominal pain. Patient is a diagnosed case of ALL
presenting with body weakness, anemia and hematoma and was confirmed with flow cytometry since
2 months prior to her present admission. She has been receiving 8 doses of L-asparaginase and
Prednisone (60mg/day for a week then 40mg/day for 3 weeks) for one month before her admission.
One week prior to hospitalization, the patient had nocturia, polyuria and polydipsia. On the day of
admission, she
had sudden onset of dyspnea associated with severe abdominal pain and vomiting.
She came in non-ambulatory, in cardiorespiratory distress with BP: 100/70mmHg, HR: 150/min, RR:
60/min, Temp: 37.3̊
C. Pertinent physical exam showed signs of dehydration with
abdominal
tenderness, and signs of circulatory compromise. Fluid resuscitation was immediately given. The initial
assessment at the ER was pancreatitis but the serum amylase and lipase were normal. Other lab
work-ups showed blood glucose of 26.8 mmol/L (NV:3.08-7.92), sodium at 115 mmol/L(NV:132-143),
potassium of 3.3, Chloride at 88mmol/L (NV: 98-116). Blood gas showed ph of 7.1, a pCO2: 50, HCO3
at 3.7, and a base deficit of -22.5mmol/L. Urinalysis showed +4 of glucose and +3 of ketones. The
patient was then managed as a case of DKA and fluid resuscitation was continued and insulin drip
was started. The HbA1c level at diagnosis was 11.4% but the C-peptide was normal. Patient condition
improved and was discharged with insulin injection. The insulin was discontinued after completion of
her induction phase and with normalization of blood glucose.
Conclusion:
Early recognition of the precipitating factors for DKA is important to prevent L-
asparaginase fatal consequences.
